Abstract

Over the years, infiltrative oxygen-ozone therapy has shown clinical benefits in several musculoskeletal disorders, due to its potential analgesic, anti-inflammatory, antioxidant and immunomodulatory effect. Ultrasonography is a safe, non-invasive imaging, easily available, and has the additional advantage of being real time for imaging and image-guided procedures of the musculoskeletal system. This review explains the numerous promising ways in which ultrasonography can be useful in oxygen-ozone therapeutic practices for musculoskeletal disorders, in order to improve safety and accuracy of treatment.

Paramedian sagittal oblique view.Note: The sacrum (arrowhead) is recognizable as a horizontal hyperechoic curvilinear structure, the L3–5 laminae (arrows) have the typical "sawtooth" appearance, and the erector spinae muscles (asterisk) are hypoechoic and lie superficial to the laminae. The images were obtained by means of a Sonoscape P50 Ultrasound (Sonoscape Europe s.r.l., Rome, Italy). The O2–O3 mixture was produced by means of a Multiossigen Medical 99IR generator (Multiossigen S.p.A., Gorle, Bergamo, Italy).

Midline sagittal spinous process view, when the transducer is positioned directly over the midline.Note: The occiput (arrowhead), spinous process of C1(rudimentary)–C2–C3–C4 (arrows) can be easily identified. The images were obtained by means of a Sonoscape P50 Ultrasound (Sonoscape Europe s.r.l., Rome, Italy). The O2–O3 mixture was produced by means of a Multiossigen Medical 99IR generator (Multiossigen S.p.A., Gorle, Bergamo, Italy).

Transverse spinous process view, when the transducer is positioned directly over the spinous process at the C4 level.Note: Spinous process is small and bifid (arrows). The images were obtained by means of a Sonoscape P50 Ultrasound (Sonoscape Europe s.r.l., Rome, Italy). The O2–O3 mixture was produced by means of a Multiossigen Medical 99IR generator (Multiossigen S.p.A., Gorle, Bergamo, Italy).

Medial epicondylitis ultrasound-guided infiltration.Note: (A) The bony prominence of medial epicondyle (ME) is easily recognizable (asterisk). The needle (arrowheads) is positioned in the peritendinous soft tissue, near the tendon insertion. (B) The O2–O3 mixture (arrows) appears as hyperechoic area in the peritendinous soft tissue with a well-defined shadow that obscures the medial epicondyle below. The images were obtained by means of a Sonoscape P50 Ultrasound (Sonoscape Europe s.r.l., Rome, Italy). The O2–O3 mixture was produced by means of a Multiossigen Medical 99IR generator (Multiossigen S.p.A., Gorle, Bergamo, Italy).

Intramuscular paravertebral injection at L5 level.Note: The O2–O3 mixture (arrows) appears as hyperechoic area with a faint shadow. The images were obtained by means of a Sonoscape P50 Ultrasound (Sonoscape Europe S.p.A., Rome, Italy). The O2–O3 mixture was produced by means of a Multiossigen Medical 99IR generator (Multiossigen S.p.A., Gorle, Bergamo, Italy).